Multiple Choice Questions (MCQ)

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Category: Cardiology--->Assessment for Surgery
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Question 1# Print Question

A 75-year-old man is referred for elective preoperative assessment. He is a smoker with a 40 pack-year history and diet-controlled diabetes. Baseline blood tests including renal function are normal.

Which one of the following factors would make you consider that further investigation was needed to assess his cardiac risk?

A. His planned surgery was a total hip replacement
B. His planned surgery was iliac aneurysm bypass surgery
C. His age
D. LVH on his resting ECG
E. His history of diabetes

Question 2# Print Question

You are asked to review a patient on a surgical ward who has been admitted for colonic surgery the next day to remove a tumour. You discover that she has a history of ischaemic heart disease and underwent elective PCI to the LAD 18 months previously. She is currently taking aspirin, ramipril, and simvastatin. She has a resting heart rate of 80 bpm in sinus rhythm. Her blood pressure is 105/80 mmHg. She is euvolaemic. The surgeon wishes to stop the aspirin prior to the surgery.

Which one of the following medication changes do you recommend?

A. Stop aspirin, as the risks of postoperative bleeding outweigh the cardiac risks
B. Start a beta-blocker in order to minimize her cardiac risks
C. Stop the simvastatin, as statins are associated with an increased risk of cancer
D. Continue aspirin despite the risks of bleeding
E. Give a long-acting nitrate to help with perioperative ischaemia

Question 3# Print Question

You review a 45-year-old man in clinic. He is due to have surgery on his knee ligaments in 4 weeks’ time. He is a smoker and has a strong family history of ischaemic heart disease. He is normotensive. He tells you that he is a keen swimmer and footballer, and injured his knee whilst training for a marathon recently. He currently finds it hard to walk unaided. Routine examination and resting ECG are normal.

Which one of the following statements best describes your approach?

A. He needs no further assessment prior to surgery
B. He should have an exercise tolerance test
C. He should have a myocardial perfusion scan
D. He should have a stress echocardiogram
E. He should have a coronary angiogram

Question 4# Print Question

Which one of the following statements is not true regarding management of a pacemaker/implantable cardiac defibrillator during non-cardiac surgery?

A. Avoid surgical diathermy/electrocautery where possible
B. If surgical diathermy/electrocautery is essential, monopolar surgical diathermy/ electrocautery is preferred
C. Programme an ICD prior to surgery to a ‘monitor’ only mode
D. Programme a pacemaker to avoid or minimize inappropriate inhibition, or high rate pacing through the ‘tracking’ of electrical interference
E. In emergency situations, consider positioning a clinical magnet over the ICD/pacemaker implant site to inhibit shock therapy (for ICDs) or cause asynchronous pacing (for pacemakers)

Question 5# Print Question

You are asked to review a 76-year-old man who has been admitted to a surgical ward with bowel obstruction. A CT scan suggests that a colonic malignancy is responsible. Urgent surgery is planned to relieve the obstruction. The anaesthetist has asked for your advice since the patient reports limiting angina and is not normally able to climb two flights of stairs without becoming breathless. He currently takes aspirin, ramipril, simvastatin, and bisoprolol. Your initial assessment concludes that he is currently free from angina and is euvolaemic with no signs of cardiac failure. His resting ECG demonstrates lateral T-wave inversion.

What would be your most likely response?

A. Surgery needs to be postponed until he has had an echocardiogram
B. Surgery needs to be postponed until he has had an exercise echocardiogram
C. Surgery needs to be postponed until he has a stress echocardiogram
D. Surgery should go ahead since his life would be at risk without it
E. His cardiac status is such that an operation is high risk and should never be considered

Category: Cardiology--->Assessment for Surgery
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